Medicare Advantage audits reveal widespread overbilling

By Ayla Ellison Newly released audits from CMS reveal 35 of 37 health plans audited for 2007 overcharged the federal government and were typically overpaid by several hundred thousand dollars, according to NPR. The audits were obtained by the Center for Public Integrity through a Free
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Hospital Surgery Rates for Workers’ Compensation Vary Widely

Insurance Journal Hospital rates for outpatient surgery paid by workers’ compensation vary significantly across states with states with fixed fee schedules having lower surgery costs for injured workers. Workers compensation costs for injured worker surgery also vary a great deal from
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10 things to know about America’s high-cost, high-need population

By Morgan Haefner  High-need adults — those with three or more chronic diseases and functional limitations inhibiting self-care or daily tasks — are seated with some of the highest medical costs. An analysis from The Commonwealth Fund using 2009 to 2011 Medical Expenditure Panel Surve
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More U.S. counties to see Obamacare marketplace monopoly: analysis

By Trevor Hunnicutt Nearly a third of U.S. counties likely will be served by only one insurer that participates in an Affordable Care Act (ACA) marketplace in 2017, according to an analysis published on Sunday by the Kaiser Family Foundation. Read more…
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Think safety net hospitals are set up to fail on readmissions? Here’s how one is succeeding

By Elizabeth Whitman NEW YORK CITY—During her 9½ years as director of nursing at Bellevue Hospital’s emergency department, Susanne Greenblatt came to know many of its regulars on a first-name basis.“The one yesterday? He comes in every day,” said Greenblatt, now associate execut
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Preliminary Data on Insurer Exits and Entrants in 2017 Affordable Care Act Marketplaces

By Cynthia Cox & Ashley Semanskee The following charts provide a preliminary picture of the potential effect insurer exits and entrants may have on competition and consumer choice in the Affordable Care Act (ACA) marketplaces. This analysis was done at the request of the Wall Stre
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Here’s More Bad News for Obamacare

By Chris Matthews Employment is rising, the housing market is coming back, and stocks are hitting record highs. In the September 1st issue of Fortune, a version of this article ran alongside “The Real Reasons Americans Think the Economy Is So Bad,” about why most Americans still think
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Consultants aggressively compete to help insurers use big data, manage costs

By Bob Herman Deborah Norton is keenly aware health insurance consultants and vendors are everywhere, ready at the drop of a hat to help rip out costs or find ways to bolster revenue. “I get dozens of emails every single day from companies telling me they can solve my problems,” said
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Health First settles antitrust suit on second day of trial

Written by Ayla Ellison Rockledge, Fla.-based Health First has reached a settlement with Melbourne, Fla.-based Omni Healthcare and a group of physicians, resolving a nearly three-year-old antitrust suit accusing Health First of maintaining a monopoly in southern Brevard County through
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Health Insurers Use Process Intended to Curb Rate Increases to Justify Them

By ROBERT PEAR WASHINGTON — After the Affordable Care Act took effect in 2010, it created a review mechanism intended to prevent exorbitant increases in health insurance rates by shaming companies that sought them. But this summer, insurers are turning that process on its head, using
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